Upper respiratory disorders. First question. A patient with acute laryngitis is being discharged.
What discharge instruction is most important to include? Limit fluid intake to prevent throat irritation. Whisper instead of talking to prevent vocal strain.
Avoid humidified air as it could worsen the symptoms. Or avoid smoking and exposure to secondhand smoke. Very good. How did our, let's talk about this.
But anyway, it's avoid smoking. You always avoid smoking. Always. A hundred percent. So this person has laryngitis, larynx.
That's what your voice box. That's inflammation of the larynx. So what teaching is going to be important?
You're going to teach them to stay away from anything that can cause irritation to the larynx, irritation to the area, such as smoke. Okay. Limit fluid intake because it can prevent throat irritation.
No, dryness will cause a throat irritation. Fluids will help to soothe that area. So that's false.
Whisper instead of talking to the patient. Actually, guys, guess what? Whispering is harder on the vocal cords than speaking normally. So you're going to teach the patient not to whisper. And last, avoid humidified air.
You know what humidified air is? That's moistened air. We love moistened air because that dry air, that dryness will cause more irritation to the area. So the only correct answer is stay away from smoke. Stay away from smoking and secondhand smoke because it's irritating.
And by the way, smoking causes vasoconstriction amongst many other things. A patient with acute pharyngitis is complaining of a sore throat and difficulty swallowing. What's the priority nursing intervention?
Would it be to administer acetaminophen as ordered? Would it be to encourage frequent gargling with warm salt water? Would it be to offer the patient ice chips and cool liquids?
Or would it be to assess the patient's airway and respiratory status? Very good. Most of you guys got it correct. You're going to assess the patient's airway. Who cares about anything else if the patient's airway is obstructed and they can't breathe, so they're dead?
Do we care about giving them water or something cool or anything else? No. So assessing that patient's airway, making sure there's no obstruction, making sure that patient can breathe, that's going to be your first priority. Before giving acetaminophen, because we don't care about giving acetaminophen if they're right.
Encouraging frequent gardening with a warm room. salt, water? Nope. And by the way, that's another slide. So I won't talk about that now.
And offering the patient, who cares about any of that? If our patient's not breathing, you want to make sure that airway is intact. Okay. So for this question, they're talking about pharyngitis.
Notice guys, when something ends in itis, that means inflammation of whatever word was in front of it. So pharyngitis is inflammation of what? The pharynx, the pharyngeal walls.
Now. the classic signs and symptoms. Can you guys tell me, go ahead and type your answer. What are the classic signs and symptoms of pharyngitis?
There's four of them. Nobody knows. Oh, you guys are killing me.
I'm so happy I asked this question. Are you guys serious right now? Okay, guys, let's just talk about this. The four classic symptoms of pharyngitis that you- guys need to know. This is so crazy.
So the first one is a fever, the patient having a fever higher than a hundred point four. The other one is cervical lymph node enlargement. The third one is having like exudate, like a tonsillar or pharyngeal exudate. And the fourth one, which everybody, not everybody, but a lot of you guys on the live type cough, but no, the absence of a cough. So having a temp.
of 100.4 or higher, having that cervical lymph node enlargement, having that exudate that's coming from the tonsils or the pharynx, and not having a cough, the absence of a cough. Those four are the classic signs of pharyngitis. Why am I saying this to you? Because you're going to see it on a test somewhere.
Don't say I didn't warn you. You guys need to know those four as those classic symptoms of pharyngitis. All right, which of the following patients is at highest risk for developing sleep apnea?
Is it a 65-year-old male with a history of hypertension and obesity? Is it a 30-year-old female with no significant past medical history? Is it a 40-year-old male who smokes but maintains an ideal weight? Or is it a 55-year-old female who's physically active and has a healthy BMI? Very good.
Very, very good. We have three red flags here for sleep apnea. Number one, older. Number two, male. Number three, obesity, right?
I like how you guys were thinking, 11 of you that chose the 40-year-old that's a smoker because, yes, smoking is going to put you at risk for sleep apnea, but that's one red flag versus the first one, which had three red flags, okay? So they're at the highest risk. A patient with sinusitis has severe nasal congestion.
Which of the following medications is most appropriate to relieve the congestion? Would it be antihistamine? Would it be a decongestant? Would it be a corticosteroid nasal spray?
Or would it be an antibiotic? If you couldn't get into the Kahoot, you can just type your answer on the live guys. Very good.
If you go to the question, the question's asking you which would be appropriate to relieve congestion. So would that not make sense that to relieve the congestion, we would give the patient a decongestant? Hello? It's right there in the question.
That was an easy one. 17 of you guys chose antihistamines. We give antihistamines for allergic reactions, okay? 26 of you guys chose corticosteroid nasal spray. We would give that for something like allergic rhinitis.
And last, antibiotics, we would give that for a bacterial infection. But in this case, we're talking about sinusitis. Inflammation of the sinuses usually is due to infection. So the patient has nasal congestion.
That's what's happening. And they're asking what we're going to expect to give to relieve the congestion. Duh, a decongestant.
Oh, Irene, you'll get used to me yelling at you. I'm sorry. I don't even know when I'm doing it. All right.
A patient presents with facial pain, purulent nasal drainage, and a fever of 101. What would the nurse suspect? Would it be acute bronchitis? Would it be sinusitis?
Would it be tonsillitis? Or would it be laryngitis? Look at these symptoms. Facial pain, purulent nasal drainage. Fever.
What do you think? Very good. Very good.
Sinusitis. Now, out of these symptoms that we're looking at, if you had to choose one symptom that made you go to sinusitis and not anything else, what would it be? Because these symptoms we can see in other disorders. What is the one symptom that you saw and it made you immediately go to sinusitis? Thank you, Mason.
Oh, Mason, looks like you're the only one who knows what you're talking about. Okay. Two people. Wow.
Most of you guys are wrong. Most everyone is saying nasal drainage. Well, there are lots of nasal drainage and lots of these upper respiratory disorders. But that face pain. Face pain.
What do you think is causing that face pain? In sinusitis, guys, what's happening is that fluid, the mucus is supposed to drain through the nose. It's getting blocked, so it's just accumulating in the sinuses.
What happens to fluid that doesn't move? infection, right? Bacteria starts to grow.
The patient can get a virus. Fungus starts to grow. It's a perfect medium for the patient to get an infection. And so the face pain is from the sinuses.
That fluid that's accumulating that has now caused irritation has caused inflammation. That's what's causing the face pain. Purulent nasal drainage, we see that in other disorders.
Fever, we see that in lots of disorders. But face pain, not too many. Sinusitis.
Thank you. Open arms cleaning set. Tap the screen, guys. Show some love, please.
Thank you. All right. Select all that applies. A patient's diagnosed with chronic rhinitis.
Which of the following should the nurse educate the patient to avoid? Select all that apply. How do we treat select all that apply?
True or false? Here are your choices. Dust and allergens.
hot and spicy foods, NSAIDs, dairy products, perfumes, and strong odors, head dander. The patient has chronic rhinitis. What things are you going to tell the patient to avoid?
Thank you, DMA. Okay. Let's talk about this.
Dust and allergens, true. Chronic rhinitis, guys, this is long-term inflammation of those nasal passages where the patient's going to have the stuffiness, the runny nose, the watery eyes or nose, decreased sense of a smell, right? But long-term. So you're going to tell them to stay away from dust and allergens that can cause those symptoms. Hot and spicy foods, no.
Someone who just had a tonsillectomy. Yeah, you're going to tell them to stay away from hot and spicy foods. Someone with GERD, yes, but not chronic rhinitis. How about NSAIDs? No.
Someone with epitaxias, right? You tell them to avoid NSAIDs. We don't want more bleeding. Dairy products?
No. Maybe someone who's lactose intolerant. Perfumes and strong odors?
Yes. That can cause those symptoms that I just mentioned. Absolutely. And of course, pet dander.
So dust and allergens, perfumes, strong odors, chemicals with strong smells like Clorox, bleach, pet dander. You tell them to stay away from those types of things. You're providing discharge instructions to a patient with allergic rhinitis.
Which statement indicates a need for further teaching? I will avoid exposure to pets and pollen. I will take my nasal decongestion daily to prevent the symptoms. I should wash my hands frequently to prevent infections.
I will use a humidifier to help relieve nasal congestion. Very good. I will take my nasal decongestant daily to prevent symptoms. First of all, we're talking about allergic rhinitis.
So this patient has inflammation of the nasal passages, right? And the reason that they have it is because of an allergen. So what you're going to teach them is stay away from the triggers, stay away from the things that can cause them to have the allergic reaction.
That's the problem. You see nasal decongestants daily. Guess what? That's going to cause a rebound. Oh my gosh.
What's the word I'm looking for? The correct term is not in my head, but I'm going to say rebound congestion. Do you guys know the term?
Because I can't think of it. But anyway, when you use these decongestants for more than like two days, what happens is it actually causes more obstruction and congestion. So absolutely not. And the problem is allergic reaction. So you're going to teach the patient to stay away from triggers.
No, not rebound medication. Thank you. Yes. rebound medicamentals gosh i'm not even gonna try to pronounce it but you see it that's the word i was looking for that i can't even pronounce thank you So anyway, the decongestion, you use it for more than two, three days tops.
That's what will cause the obstruction and even more congestion. And at the end of the day, the problem are the triggers, right? So even if they were using decongestant, if they're still being exposed to the triggers, they're still going to have these type of reactions. By the way, something important to know about allergic rhinitis. First line treatment is going to be corticosteroid sprays.
Professor D, do I need to know that? Yes. You're going to see it on a test somewhere within your academic career. Don't say I didn't warn you.
I'm going to try to say that word. Rebound medical mentosa. I said it wrong.
Forgive me, guys. You know what I mean? But that's the word I was thinking in my head that I just can't say.
All right. Patient with epistaxis is being treated in the emergency department. Which action by the nurse is appropriate?
Is it apply warm compresses to the back of the neck? Instruct the patient to tilt the head backward, pinch the nostrils together for 10 to 15 minutes. Instruct the patient to blow the nose forcefully.
Very good. Pinch the nostrils together for 10 to 15 minutes. So what is epistaxis? Nosebleed. And so you want to apply pressure, not on the bone, not all the way up here.
That does nothing. That's the bone, right? On the soft portion, the nostrils for 10 to 15 minutes, you want to apply pressure.
to stop the bleeding. You're going to have the patient lean forward. I'm about to age myself because back in the day before we knew better, we used to have the patient lean back and have their head back, but then we learned what are they doing?
They're swallowing their blood, right? So we want them to lean forward. Applying warm compresses.
First of all, warmth causes vasodilation. It would increase bleeding. That's number one. And then number two, to the back of the neck, it's a nosebleed. Why are we doing anything to the back of the neck?
That makes no sense. Next, instruct the patient to tilt. their head backwards.
No, we do not do that. You tilt forward. We don't want them to swallow that blood and then instruct the patient to blow the nose.
What? Forcefully? No, you're going to cause trauma to that area. Absolutely not.
Which of the following interventions should you prioritize for a patient who underwent a tonsillectomy? So they just had a tonsillectomy. Offer ice cream and cold liquids. Monitor for frequent swallowing, which may indicate bleeding.
Provide warm saltwater gargles for pain relief. Position the patient flat to prevent aspiration. What do you guys think? Thank you, Mamaruth. Very good.
Very good. You want to monitor for frequent swallowing. Looking at them and you see them, they keep swallowing.
They're gulping. What do you think they're gulping? Blood.
Maybe there's internal bleeding going on, right? And so for this type of patient, you want to make sure there's no active bleeding going on. That's why you're going to, and also you're going to give them cold drinks.
We want vasoconstriction, not dilation. Let's say you give them ice cream. It's not going to be strawberry ice cream where it's pink because guess what?
If the patient's bleeding, we might not be able to tell because the ice cream was already pink tinge, right? We're going to give them something like, um, and I shouldn't say ice cream because I have milk in it. Milk increases mucus. What's that thing?
Um, it's like ice cream, but it's on a stick, not ice cream. Um, guys on the live, what's it called? It's like ice cream, but it's not soft, like on a stick.
It's on a stick. Popsicle. Thank you. Thank you. Ice pop.
Yes, yes, yes. You're going to give the patient ice pops, but the ice pop is going to be what? It's going to be clear. It's not going to be red because if the patient has a bleeding going on, we need to know.
Okay. Thank you so much. Ice pop. Popsicle. That's the word I was looking for.
Not ice cream because ice cream has milk in it. and milk increases mucus production. This patient that just had surgery, you think it's a good idea for them to be doing this or trying to clear all that mucus out? Absolutely not. We don't want anything that will cause irritation or trauma to the throat, okay?
True or false? Immediately after a laryngectomy, the patient, I said that wrong, didn't I? Laryngectomy. Laryngectomy.
You guys see the word. You see what I mean. Anyway, shortly after that, the patient should be placed in the supine position.
Is this true or is this false? If you are new, this is your first time following me ever. I promise I am not an idiot. I promise you.
The word is in my head. I know what it is. I just have a speech impediment. I've always had it in lots of words.
I just cannot. pronounce, but I promise you, you can ask anyone who follows me. I know what I'm talking about. False.
After the patient has had this procedure that I cannot pronounce. Let me, first of all, let me explain to you what it is. You remember how I told you when something ends in itis, that means inflammation of whatever's in front of it.
When something ends in ectomy, that means removal of whatever's in front of it. So this word, I'm going to try to pronounce it again. Laryngectomy, laryngectomy.
the, anyway, this word is removal of the larynx, which is the voice box, right? So this patient's had this invasive procedure. They've had the larynx removed. How are you going to position the patient?
You're not going to put them flat. You're going to have them sit up. You're going to have them in semi-foulers position. Why?
You want to facilitate drainage, right? You want to make sure that patient doesn't aspirate and choke on their own fluids. excuse me, excuse me.
You want to facilitate breathing. You want the lungs to be able to expand correctly, but most important, you want to facilitate drainage. So you're going to have the patient in semifilers position. True or false?
For viral infections, antibiotics are recommended. Is this true or is this false? For viral infections, antibiotics are recommended. False.
False. How did 14 of you say true? For bacterial infections, antibiotics are recommended. Okay. But if a patient has a virus, you expect them to get what?
An antiviral agent. Antibiotics is not going to do anything for a viral infection. All right, one more.
Yes, you're an OG, but I have lots of new followers. I'm so afraid they'll think I'm an idiot. What am I going to do?
All right. Last question, select all that applies. Which allergens should be avoided in allergic rhinitis? Select all that applies. Here are your options.
House dust, dust mites, pet allergens, mold spores, pollen, smoke. Your patient has allergic rhinitis. Which allergens would you teach them to avoid? Select all that apply.
thank you open arms thank you oh i'm so proud of you guys all of them all of them all of these are triggers That should be avoided. You guys did a great job. Let's see who won.
Let's see how you did.